Anxiety and depression one year after the first stroke among Lebanese survivors: proportions, changes, and predictors.

BACKGROUND

About 1 in 2 stroke survivors suffer from anxiety and depression in the first year after stroke. This study aimed to calculate the proportions of 1-year post-stroke anxiety and depression (PSA and PSD), evaluate their changes over time, and identify the contributing factors among first-ever stroke survivors in Lebanon, where relevant research has been scarce.

METHODS

A hospital-based multicenter study was conducted among 150 subjects aged ≥ 18 years involving scheduled home visits at 3, 6, and 12 months after stroke index. Several scales were employed, including Hospital Anxiety and Depression Scale (HADS), Mini-Mental State Examination (MMSE), modified Rankin Scale (mRS), Short Form Health Survey (SF12), National Institutes of Health Stroke Scale (NIHSS), Visual Analogue Scale (VAS), Douleur Neuropathique 4 (DN4), Modified Ashworth Scale (MAS), and Fatigue Severity Scale (FSS), to assess levels of anxiety and depression, cognitive function, disability degree, quality of life, stroke severity, general pain, central pain, spasticity, and fatigue after stroke, respectively. Descriptive analyses were performed to describe baseline and stroke characteristics and to calculate proportions of PSA and PSD, followed by univariate and multivariable analyses to identify the contributing factors.

RESULTS

High HADS scores were reported in our cohort, with the most prevalent symptoms occurring within the first 3 months after stroke index (77.3% for PSD and 51.2% for PSA with HADS ≥ 8). Despite a slight decrease over the subsequent 6 and 12 months, proportions remained elevated, affecting at least 40% to 60% of survivors. PSA was a consistent independent predictor of PSD (Adjusted Odds Ratio ≅ 2). Other contributing factors to PSA and PSD were highlighted, including a history of atrial fibrillation, longer sedentary hours, high scores of NIHSS and mRS, lower scores of SF12 and MMSE, and the presence of immobility-related problems, of which high DN4 scores were independent predictors. Better 1-year psychological outcomes were noticed in those with higher educational levels and employment after stroke.

CONCLUSION

Routine psychological screening and support for stroke survivors are urgently needed. By identifying factors and emphasizing early detection, our research offers valuable insights that can inform clinical practice and improve the well-being of stroke survivors.